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\begin{document}

\title{A rare case of aberrant origin of left and right vertebral artery from
double aortic arch}



\author[1]{Dou Yuan}%
\author[2]{Zhuo Ma Xiong Qiu}%
\affil[1]{West China Hospital of Sichuan University}%
\affil[2]{West China Hospital of Medicine}%


\vspace{-1em}



  
  \date{May 27, 2024}


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\textbf{A rare case of aberrant origin of left and right vertebral
artery from double aortic arch}

Zhuoma Xiongqiu\textsuperscript{1}, Dou Yuan\textsuperscript{2\#}.

\textsuperscript{1} Department of Pediatric Intensive Care Unit, West
China Hospital, Sichuan University, Guoxuexiang 37th, 610041 Chengdu,
Sichuan, P.R. China.

\textsuperscript{2} Department of Cardiovascular Surgery, Cheng Du Shang
Jin Nan Fu Hospital, West China Hospital of Sichuan University,Chengdu
610041, Sichuan Province, China.

\textsuperscript{\#} Correspondence: Dou Yuan,, Chengdu, Sichuan,
610041, People's Republic of China; fax: + 86 28 85422897;
e-mail:\emph{yuandou123456789@aliyun.com} .

\textbf{A rare case of aberrant origin of left and right vertebral
artery from double aortic arch}

Zhuoma Xiongqiu\textsuperscript{1}, Dou Yuan\textsuperscript{2\#}.

\textsuperscript{1} Department of Pediatric Intensive Care Unit, West
China Hospital, Sichuan University, Guoxuexiang 37th, 610041 Chengdu,
Sichuan, P.R. China.

\textsuperscript{2} Department of Cardiovascular Surgery, Cheng Du Shang
Jin Nan Fu Hospital, West China Hospital of Sichuan University,Chengdu
610041, Sichuan Province, China.

\textsuperscript{\#} Correspondence: Dou Yuan,, Chengdu, Sichuan,
610041, People's Republic of China; fax: + 86 28 85422897;
e-mail:\emph{yuandou123456789@aliyun.com} .

\textbf{Key Clinical Message}

Double aortic arch (DAA) is a exceedingly rare congenital vascular
anomaly and rarely with anomalous origin~of vertebral artery, Enhanced
CT should be considered in DAA patients to identify the anomalous
origin~of branch arteries. it is not only aid in surgical planning but
also deepen our comprehension of potential embryological variations in
aortic arch development.

\textbf{KEYWORDS}

Double aortic arch; vertebral artery; enhanced CT.

A 3-year-old girl with a history of respiratory distress was referred to
emergency department, The patient was afebrile on initial evaluation
with a heart rate of 110, blood pressure of 75/40 mmHg, and an oxygen
saturation of 99\% on room air. no wheezing, crackles were present on
the auscultation of the lungs, and EKG showed normal sinus rhythm. Chest
x-ray showed tracheal indentation and suspicion of tracheal stenosis.
Echocardiography was not conclusive but raised the possibility of Double
aortic arch (DAA) . She was therefore referred for cardiac enhanced CT.
The result revealed a DAA with arch origins for left common carotid,
left vertebral, and left subclavian on the left , and right common
carotid, right vertebral, and right subclavian arteries on the
right(figure 1A and 1B).The girl subsequently underwent division of the
left arch, distal to the origin of the left subclavian artery to relieve
the vascular compression on the trachea. Postoperative recovering was
uneventful.

Double aortic arch (DAA) is a exceedingly rare congenital vascular
anomaly, with one in 15,000 births accounting for only 1\% of all
congenital heart diseases\textsuperscript{1}. This disease is the most
common type of complete vascular ring, which easily compresses the
trachea and/or esophagus to cause A spectrum of signs and symptoms such
as dysphagia, vomiting, respiratory distress, wheezing, and
stridor\textsuperscript{2}. Vertebral artery (VA) typically emanates
from the supero-posterior aspect of the 1st part of the subclavian
artery and Variations of the VA origin usually occur in the congenital
heart disease\textsuperscript{3}. We herein report a double aortic arch,
with arch origins for left common carotid, left vertebral, and left
subclavian on the left , and right common carotid, right vertebral, and
right subclavian arteries on the right . To our knowledge, a DAA with a
direct aortic origin of the right and left VA from two arches have not
been reported.

Therefore Enhanced CT should be considered in DAA patients to identify
the anomalous origin~of branch arteries, because noninvasive
cardiovascular imaging have unveiled rare variations in aortic arch and
such insights not only aid in surgical planning but also deepen our
comprehension of potential embryological variations in aortic arch
development.

\textbf{AUTHOR CONTRIBUTIONS}

All authors were involved in the conception and design, critical
revision, manuscript writing, final approval, and agreed to be
accountable for all aspects of the work.

\textbf{FUNDING INFORMATION}

No funding was required in the preparation of this case report.

\textbf{DATA AVAILABILITY STATEMENT}

All data generated or analyzed during this study are included in this
published article.

\textbf{ETHICS STATEMENT}

This study is in compliance with the declaration of Helsinki.

\textbf{CONSENT}

Written informed consent was obtained from the patient for publication
of this case report in accordance with the journal's patient consent
policy.

REFERENCES

\begin{enumerate}
\tightlist
\item
  Bartsota M, Jowett V, Manuel D, et al. Double aortic arch:
  implications of antenatal diagnosis, differential growth of arches
  during pregnancy, associated abnormalities and postnatal
  outcome.\emph{Ultrasound Obstet Gynecol} . 2023;62(1):69-74.
\item
  Biermann D, Hazekamp MG. Vascular ring surgery: future trends and
  challenges in diagnosis and treatment. \emph{Eur J Cardiothorac Surg}
  . 2022 May 27;61(6):1269-1270.
\item
  Lazaridis N, Piagkou M, Loukas M, et al. A systematic classification
  of the vertebral artery variable origin: clinical and surgical
  implications. \emph{Surg Radiol Anat.} 2018 ;40(7):779-797.
\end{enumerate}

\textbf{FIGURE} 3D contrast-enhanced CT: (1A) left sagittal view,
showing the left common carotid artery (LCCA), left vertebral artery
(LVA), and left subclavian artery (LSCA) on the left aortic arch (LAA),
as well as the (B) right sagittal view, showing right common carotid
artery (RCCA), right vertebral artery (RVA), and right subclavian artery
(RSCA) on the right aortic arch.\selectlanguage{english}
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